Permit ►.
CITY TI GARD SEWER CONNECTION PERMIT
I� DEVELOPMENT SERVICES
PERMIT #: SWR2004 -00279
oh!, DATE ISSUED: 11/5/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 08053 SW LEISER LN PARCEL: 2S112BC -13900
SUBDIVISION: LEISER PARK ZONING: R - 4.5
BLOCK: LOT: 008 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: New SF sewer connection
Owner: FEES
LEGEND HOMES Description Date Amount
12755 SW 69TH AVE #100
PORTLAND, OR 97223 [SWUSA] Swr Connecti( 11/5/2004 $2,500.00
[SWUSA] SwrConnectic 11/5/2004 $0.00
Phone: 503- 620 -8080 [SWINSP] Sewer Inspect 11/5/2004 $35.00
[ SWINSP] Sewer Inspect 11/5/2004 $0.00
Contractor:
Total $2,535.00
Phone:
Reg #:
Required Inspections
•
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180
days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee
the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect
3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and Side Sewer"
Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You
may - obtain -co ies- of- these- rules -or- direct questions to OUNC -by- calling (503) 246 -6699.
Issued by. Permittee Signature
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business